Finding realistic solutions to NTD target delays
Authors: Antonio Montresor, Albis Francesco Gabrielli
Journal: The Lancet Global Health (2022)

Every year since 2016, more than 1 billion individuals have been reached with public health interventions to control neglected tropical diseases (NTDs). In 2020 and 2021, however, due to the disruptions caused by the COVID-19 pandemic to health services, the number of individuals reached by these interventions dropped significantly.1WHOSummary of global update on implementation of preventive chemotherapy against NTDs in 2020.Wkly Epidemiol Rec. 2021; 96: 468-475Google Scholar, 2WHONeglected tropical diseases: progress towards recovery from COVID-19—2022 update.Wkly Epidemiol Rec. 2022; 97: 465-480Google Scholar In The Lancet Global Health, Anna Borlase and colleagues3Borlase A Le Rutte EA Castaño S et al.Evaluating and mitigating the potential indirect effect of COVID-19 on control programmes for seven neglected tropical diseases: a modelling study.Lancet Glob Health. 2022; 10: e1600-e1611Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar report on a study conducted by applying mathematical transmission models with the aim of evaluating the negative impact of the COVID-19 pandemic on activities for the control of seven NTDs (soil-transmitted helminthiases, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, visceral leishmaniasis, and human African trypanosomiasis). The authors also discuss the consequences of these disruptions for NTD prevalence or incidence and propose some mitigating measures to be taken to avoid delays in the attainments of the 2030 targets set by the WHO NTD road map.4World Health OrganizationEnding the neglect to attain the sustainable development goals: a road map for neglected tropical diseases.https://www.who.int/publications/i/item/9789240010352Date: 2021–2030Date accessed: September 26, 2022Google Scholar As expected, the models consistently predict a delay in reaching the 2030 targets that is more significant in communities with higher endemicity. For most of the NTDs considered, the mitigating interventions proposed are feasible: they consist of conducting an additional round of mass drug administration, compensating for the one lost due to the pandemic, or enhanced case-finding. However, in the case of soil-transmitted helminthiases, the proposed solution is different: Borlase and colleagues propose to compensate for the one missed school round of benzimidazole distribution with one round of benzimidazole administration to the entire community. This recommendation may well be effective, but it is based only on infection transmission considerations. Notably, it does not take into account the associated cost, which is always an essential factor to consider in public health interventions for NTDs. The cost of reaching an individual through a house-to-house drug distribution approach is, on average, five to ten times higher than that incurred by reaching a child through school distribution5Morozoff C Avokpaho E Puthupalayam Kaliappan S et al.Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi.BMJ Open. 2022; 12e059565Crossref PubMed Scopus (1) Google Scholar, 6Montresor A Gabrielli AF Diarra A Engels D Estimation of the cost of large-scale school deworming programmes with benzimidazoles.Trans R S Trop Med Hyg. 2010; 104: 129-132Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 7Mondadori E Ehrhardt A Anh TL Cong DT Sepe G Huyen NV Montresor A High appreciation of school deworming programme by parents in Ha Giang Province (Vietnam).Southeast Asian J Trop Med Public Health. 2006; 37: 1095-1098PubMed Google Scholar in which the school is used as support infrastructure and the drugs are distributed within each class by teachers at minimal cost.6Montresor A Gabrielli AF Diarra A Engels D Estimation of the cost of large-scale school deworming programmes with benzimidazoles.Trans R S Trop Med Hyg. 2010; 104: 129-132Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar On the contrary, the house-to-house approach faces important costs due to the increased complexity of the activity and the need to recruit distributors. In addition, since the mebendazole is proposed to be distributed to the adults as well, the total population to be targeted is approximately three times the number of the school children. Taking these very basic data into consideration, we can estimate that the proposed mitigation measure would cost between ten times (if children are reached by the school system and the adults by the house-to-house distribution) and 15 times (if children are also reached through house-to-house distribution) the cost of the missed round of school deworming. Considering that the control programmes for soil-transmitted helminthiases are normally running with few funds and a limited quantity of donated medicines, it is likely that neither resources would be sufficient to implement the proposed intervention. It is our opinion that the formulation of recommendations on control interventions in the area of NTDs should also take into consideration programmatic aspects such as those mentioned above. In the case of soil-transmitted helminthiases, more frequent rounds of treatment with no expansion of the target population, as recommended for most of the other NTDs considered by the authors, could be a more practical solution than targeting adults. We would like to take this opportunity to invite Anna Borlase and colleagues to investigate whether the desired effect of the two approaches would be comparable or not. This Comment reflects the views of the authors and not necessarily the views of WHO. We declare no competing interests. Evaluating and mitigating the potential indirect effect of COVID-19 on control programmes for seven neglected tropical diseases: a modelling studyThe COVID-19 pandemic has brought infectious disease control to the forefront of global consciousness. It is essential that the NTDs, so long neglected in terms of research and financial support, are not overlooked, and remain a priority in health service planning and funding. Full-Text PDF Open Access